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Ermelindo Puente - Assuming Office 2004 ,""h,,',f,tl" CALlFORN 11\ FORM 700 FAIR POLITICAL PRACTiCeS COMMISSION (MIDDLE) STATEMENT OF ECONOMIC INTERESTS COVER PAGE Please type or print In Ink A Public Document NAME (lAST) (FIRST) u 11 Te MAILING ADDRESS STREET (May be business addl1lss) ?~ :n STAle ZIP CODE OP11ONAL: FAX I E-MAIL ADDRESS 1. Office, Agency or Court Name of Office, Agency or Court: C \ It:\; ~ F (b.r J-.. r 0 I- Division, B6ard, District, if applicable: . P L q YI n; V1~ COm m /5 5J~h Your Position: t? CfJ in/h / 5 S ;' () n e r _ If filing for multiple positions, list additional agency(ies)/ position(s): (Attach a separate sheet if necessary.) Agency: CO- Position: ~lufl( 2. Jurisdiction of Office (Check at least one box) o State o County of ill City of G,,. I ro 't o Multi-County o Other 3. Type of Statement (Check at least one box) 161 Assuming Office/Initial Date: ~~~y ~-Annual: The period covered is January 1, 2003, '?) through December 31, 2003. -or- C The period covered is ---1---1_. through December 31. 2003. o Leaving Office Date Left: ---1---1_ (Check one) o The period covered is January 1, 2003, through the date of leaving office. -or- C The period covered is ---1---1_. through the date of leaving office. o Candidate 4. Schedule Summary (Check applicable schedules or "'No repombl. Interests. ., _ During the reporting period, did you have any reportable interests to disclose on: · Schedule A-1 0 Yes - schedule attached Investments (u.s; lhan 10% O~) Schedule A-2 0 Yes - schedule attached Investments (10% or gma/Dr O~p) Schedule B Real Property DYes - schedule attached Schedule C 0 Yes - schedule attached Income & Business Positions (Income 0Iher Ihan loaM, Gills, and 1laveI} Schedule D 0 Yes - schedule attached Income .l Loans Schedule E 0 Yes - schedule attached Income - Gifts Schedule F 0 Yes - schedule attached Income - - Travel Payments -or- _ ~ No reportable interests on any schedule Total number of pages completed including this cover page: I 5. Verification I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Signed /-30 - CP4 (month, day, year) Signature ( (2003/2004) FPPC Toll-Free Helpline: 866/ASK.FPPC